Provider Demographics
NPI:1811137839
Name:MCDANIEL, EILEEN (MA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 AUBURN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1846
Mailing Address - Country:US
Mailing Address - Phone:626-470-9834
Mailing Address - Fax:
Practice Address - Street 1:37 AUBURN AVE STE 1
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1846
Practice Address - Country:US
Practice Address - Phone:626-470-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98899106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7667OtherMEDI-CAL
CA7368OtherMEDI-CAL
CA7708OtherMEDI-CAL
CA7184OtherMEDI-CAL